Elder Law Firm of Marshall & Associates

Frail Seniors May Lose Home Care Support

Written By: Attorney Jeffrey A. Marshall , CELA*

An estimated 1,500 married seniors could lose their home care benefits due to a change in Medicaid law passed by the PA Legislature in July.

The seniors receive assistance with home care costs under the PA Department of Aging 60+ Waiver program.

The Waiver program helps pay for home services for seniors who are nursing facility clinically eligible – they are so frail that they would qualify for nursing home care. Under this Medicaid-funded program, seniors who qualify can receive a limited number of hours of assistance to allow them to live at home instead of in a nursing institution.

Families remain responsible for providing most of the needed care. The Waiver program merely supplements the help provided by families who must still meet most of their loved one’s care needs.

The Waiver program saves money for the state because funding home care costs Medicaid less than half of the cost of nursing facility care. The program relies on unpaid family members rather than paid nursing home staff to provide the primary support for the frail senior.

It represents a partnership and sharing of responsibility between government and families to meet the care needs of chronically ill seniors. It is a family support program that rewards personal responsibility and keeps families together.

In the past, the state tried to encourage married couples to choose home care over nursing facility care. To make it easier to financially qualify for home Waiver care, Pennsylvania did not pool together the assets of both spouses. The savings of the healthier spouse were not counted.

Act 42 changed the rules. Section 441.8 of Act 42 requires that the resources of the non-applicant community spouse be counted. The new rules took effect on October 1^st. As a result, it is now more difficult to qualify financially for home care than for nursing facility care.

The change in the law is not limited to new applicants for Waiver. Act 42 affects an estimated 5,000 married seniors who are currently receiving benefits under the Waiver program. All will have to file financial “Resource Assessment” forms.

It is estimated that approximately 1,500 current Waiver recipients will lose their financial support by Marc h 31, 2006 . Married couples receiving Waiver services should discuss their status with their Area Agency on Aging care manager. Those who will lose benefits should discuss their options with an elder law attorney.

Section 441.8 of Act 42 represents a curious policy decision by the state. It will discourage families from choosing the home care option in favor of more costly nursing facility care. It wastes family care-giving resources. It separates families.

It may end up costing the state more than it saves, since many seniors whose care needs could be met at home with just a little government assistance, will instead be institutionalized.

Nevertheless, it is now the law in Pennsylvania .

Attorney Marshall ’s article was originally published in the Insights & Opportunities section of the Williamsport Sun-Gazette on Sunday, October 23, 2005.

A copy of the Department of Public Welfare Operations Memorandum which implements Section 441.8 of Act 42 is available on the Marshall & Associates website at http://www.paelderlaw.com/pdf/operationsmemo.pdf.

Attorney Marshall can be contacted at webmail@paelderlaw.com or at 1-800-401-4552

GAO Issues Report on Long-Term Care Insurance Partnership Program

Written By: Attorney Jeffrey A. Marshall , CELA*

The Government Accounting Office (GAO) has issued a report on The Long Term Care Partnership Program. The Program is a public-private partnership between states and private insurance companies that is designed to encourage the purchase of private long term care insurance to reduce Government Medicaid spending on long term care.

In 2003, national spending on long-term care totaled $183 billion, with nearly half paid for by the Medicaid program. Private insurance paid only a small portion of this long-term care spending - about $16 billion or 9 percent in 2003. Congress is seeking ways to shift more of the underlying cost of long term care financing away from the government and onto individuals. It is likely to authorize the expansion of the Long Term Care Partnership Program to encourage more individuals to purchase long term care insurance.

Under the Program, policyholders who buy a designated private long-term care insurance policy and later use it to pay for services will be allowed to protect additional resources from Medicaid spend-down requirements. Individuals must still meet Medicaid income requirements.

Currently, Partnership policies may be sold only in four states -- California , Connecticut ,

Indiana , and New York . Congress is considering opening the Partnership Program to other states, including Pennsylvania . Pennsylvania legislators have expressed interest in permitting Commonwealth residents to participate in the Program.

The GAO report provides summary information for Congress and state policymakers, such as the demographics of program participants, the types of policies purchased, and the benefits accessed by policyholders.

Whether the Partnership Program actually saves Government funds is unclear. The GAO study concludes that “it is difficult to determine whether and to what extent the Long-Term Care Partnership Program has resulted in cost savings to the Medicaid program because there are insufficient data to determine if those individuals who have purchased partnership policies would have accessed Medicaid had they not purchased long-term care insurance benefits.”

The entire report is available online at http://www.gao.gov/new.items/d051021r.pdf .

Attorney Marshall can be contacted at webmail@paelderlaw.com or at 1-800-401-4552

Health Spending in the United States Far Exceeds Other Countries

Written By: Amanda Peterson , Lock Haven University Social Work Intern

Individuals and businesses struggling with surging health care may ask why the cost of health care is so high in the United States .

According to a recent report in Health Affairs, per capita health care spending in 2002 was 53 percent higher in the U.S. than in any other country. (Health Affairs, Vol 24, Issue 4, 903-914, http://content.healthaffairs.org/cgi/content/abstract/24/4/903.)

According to the report, higher medical care prices combined with higher incomes and the cost of living seem to be the main factors.

Higher spending does not necessarily translate into better health care, access or treatment. The United States has fewer per capita hospital beds, physicians, nurses, and MRI and CT scanners than the OECD (Organization for Economic Cooperation and Development) median for other countries.

Even though the United States has a relatively lower supply of health care resources such as MRI and CT scanners, these resources may be used more efficiently than in other countries. For example the length of a hospital stay is generally shorter and more intensive than in other countries. Also, CT and MRI scanners may be used more frequently. This greater intensity of care may help explain why the U.S. has fewer health care resources, but pays higher prices for their use.

The waiting time for certain surgeries and procedures in the U.S. is also much shorter, and U.S. patients rarely wait long periods of time for certain types of elective surgeries. Waiting lists, however, are still common for appointments with physicians, emergency rooms, and in various other settings.

One possible explanation for lower costs in other countries is that waiting lists may hold down use and thus spending. However, waiting lists would only explain a small portion of the difference in health spending between the U.S. and other OECD countries.

Malpractice payouts have also been cited as a reason why the U.S. is spending so much more. In actuality, awards in the U.S. were lower on average than those in other countries such as Canada and the U.K. Overall malpractice litigation costs are quite small compared to total health spending in the U.S.

Some Americans believe that health care spending is highest in the U.S. because we provide better care to our citizens. However, with some exceptions, it does not appear that the extra spending results in better quality care or patient satisfaction or covering the uninsured. Overall, it seems that the main reason for higher per capita cost in the administratively complex and fragmented United States health care system is not that we provide better care, but just that we have higher medical care prices.

Amanda is a senior social work major at Lock Haven University who is interning with Marshall & Associates this semester. A native of Warren , Pennsylvania , Amanda has worked at Northwest Human Development in adult MH/MR residential homes and is also a case worker for Thurston House in Meadville , PA which is a teen pregnancy/parenting program.

Amanda can be contacted at webmail@paelderlaw.com or at 1-800-401-4552

IRRC Comments on Proposed Pre-Admission Requirements for Nursing Homes

Written By: Attorney Jeffrey A. Marshall , CELA*

The Independent Regulatory Review Commission (IRRC) has issued comments in regard to DPW's proposed preadmission regulations as part of the rulemaking process. By law, DPW must consider the IRRC's comments when it issues its final regulations. The comments are available online at http://www.pabulletin.com/secure/data/vol35/35-41/1866.html.

The IRRC comments note the concern of various commentators that “the requirement for completion of assessments prior to admission is impractical and will result in substantial delays for individuals awaiting admission to nursing facilities.” The IRRC requests clarification from DPW.

The comments from the IRRC are available online at http://www.pabulletin.com/secure/data/vol35/35-41/1866.html. For a copy of the proposed regulations, go to http://www.pabulletin.com/secure/data/vol35/35-31/1435.html.

Attorney Marshall can be contacted at webmail@paelderlaw.com or at 1-800-401-4552

Estate Administration in Pennsylvania

The Role of the Personal Representative in Administering an Estate

Written By: Gloria M. Kizis , Estate Administration Paralegal

You’ve been named as a Personal Representative (commonly known as an Executor or Administrator) to administer an estate. What do you do and where do you start? This article will give you an overview of your responsibilities.

Once the Orphan’s Court of the County in which the decedent resided has officially appointed you as the Estate’s Executor or Administrator, your authority to act as such is set forth in a document called “Letters Testamentary” (for estates with a Will) or “Letters of Administration” (for estates without a Will). Your work as the estate’s Executor or Administrator has now officially begun.

Some of your responsibilities will include:

1. Collect all property owned by the decedent at the time of death.

2. Contract the services of an appraiser(s) to perform the required appraisals for real and personal property.

3. Pay all valid claims from creditors in accordance with the terms of the Will.

4. File the inheritance tax return and all required income tax returns within the time frame the law dictates and pay the taxes thereon.

5. Distribute the net assets to the beneficiaries according to the terms of the accounting or Family Settlement Agreement.

The following are some questions that we are frequently asked:

1. Am I required to accept the appointment as an Executor?

Keep in mind that just because you have been appointed as an Executor does not mean you have to accept. You may renounce your appointment and the alternate Executor appointed in the decedent’s Will becomes the Executor. If there is no Will, an Administrator will be appointed.

2. As an executor or an administrator am I personally liable for the debts of the decedent?

As long as the executor or administrator properly administers the estate according to the law, he or she will not be held personally liable for any debts owed by the decedent.

3. Am I entitled to compensation for acting as an Executor/Administrator?

Yes, you are entitled to reasonable compensation. The amount of the compensation is determined by the amount of work you performed as an Executor/Administrator. Keep in mind that whatever compensation you receive from the Estate will be subject to income tax because it is income you earned. The amount of your fee is subject to review by the Court.

4. How long will it take for the Estate to be completed?

Although there is no definite answer to this question, the average estate administration takes approximately one year. Some estates may be concluded is less time and some estates may take longer. In most cases, the size of the estate and the type of assets in the estate dictate the time frame. Inheritance taxes are due 9 months after the date of death.

6. Do I need the assistance of an attorney to administer this Estate

There is no legal requirement that you must contract the services of an attorney to help you administer an Estate. However, it is good common sense. Few people have the legal knowledge or experience to properly administer an estate. Even experienced Executors usually hire an attorney. As an Executor/Administrator you may be held personally responsible if you fail to properly handle the estate or pay taxes. It is generally in your best interest and the best interest of the beneficiaries of the Estate to hire an experienced lawyer to help you through the process.

At Marshall & Associates we strive to make your work as an Executor or Administrator as easy as possible. We believe that our job is to assist and guide you through the process of Estate Administration and ensure that the Estate is administered and distributed pursuant to Pennsylvania Law.

Our Estate Administration Department is staffed by attorneys and paralegals with many years of experience in performing Estate Administration work. We are a very “hands on” law firm and we will work to make your experience as an Executor or Administrator as simple and stress-free as possible.

This article was developed to give you an overview of your responsibilities as an Executor/Administrator, and is not intended to be relied upon as legal advice. The duties of an Executor/Administrator are not limited to the responsibilities set forth in this article.

Gloria can be contacted at webmail@paelderlaw.com or at 1-800-401-4552

Attorney Marshall’s Testimony is Part of Governor’s “Listening Tour” on the Medicaid Funding Challenge

Written By: Melissa Bottorf, Director of Marketing & Public Ed ucation

In an effort to find innovative and pragmatic solutions to the funding issues surrounding Medicaid, Governor Rendell proposed a statewide listening tour. Professionals and consumers were asked to provide written testimony for senior-level state officials to consider as possible solutions that could inevitably alleviate some of the burden in both the immediate and future of Medicaid funding in the state.

Attorney Marshall posted his comments on “Real Life Medicaid Planning.” His testimony provides a glimpse into what really goes on in families faced with serious long-term care needs, why they seek legal help, and what Medicaid Estate Planning actually accomplishes.

Attorney Marshall’s testimony is available at http://www.paelderlaw.com/pdf/testimony.pdf.

His testimony along with others from across the state is available at the Department of Public Welfare website at http://www.dpw.state.pa.us/business/matour/.

Melissa can be contacted at webmail@paelderlaw.com or at 1-800-401-4552

In the Community…

The professional staff of Marshall and Associates will be presenting to the following groups and organizations over the next couple of weeks. Many of these events are open to the public. If you would like more information or would like to schedule someone to speak at your group, please contact Melissa at 321-9008 or at mbottorf@paelderlaw.com

-Planning Specialist Lisa Barner will speak about Long Term Care Planning When Diagnosed with Alzheimer’s Disease at the Catawissa Senior Center on Thursday, November 3^rd at 10:30 AM .

-Attorney Kevin Grebas and Planning Specialist Josephine Reviello will make a presentation on Ways to Pay For Long Term Care for the American Red Cross Retirees meeting on Wednesday, November 9^th at 2:00 PM .

-Attorney Kevin Grebas will present as part of the Wilkes-Barre Law & Library Associations Bench Bar Conference on Elder Law. The day-long conference will be held on Thursday, November 10^th.

-Planning Specialist Lisa Barner will talk about The New Medicare Part D Changes to the Kramm’s Health Care Center in Milton on Thursday, November 10^th at 6:30 PM .

-Planning Specialist Perry Landon will talk about Recent Changes in Long Term Care Planning at the Susquehanna Valley Alzheimer’s Support Group at Evangelical Community Hospital in Lewisburg on Sunday, November 13^th at 2:00 PM .

-Planning Specialist Perry Landon will talk about Geriatric Care Management at the Berwick Hospital Alzheimer’s Support Group on Wednesday, November 16^th at 6:00 PM .

-Planning Specialist Lisa Barner will talk about The New Medicare Part D Changes to the Christian Women’s Group at Mater Delorosa Catholic Church in Williamsport on November 17^th at 12:00 PM .

-Planning Specialist Lisa Barner will provide a presentation on The New Medicare Part D Changes to the American Women’s Business Association on November 21^st at 6:30 PM . It will be held at the Genetti Hotel in Williamsport .

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*Attorneys Marshall and Parker are certified as Elder Law Attorneys by the National Elder Law Foundation under authorization from the Pennsylvania Supreme Court.

1-800-401-4552

www.paelderlaw.com

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